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May 24, 2010

Under The Knife

Monday Update

by Will Carroll

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Brandon Webb (labrum surgery, ERD 7/10)
We've long known that the labs at the American Sports Medicine Institute (ASMI) were one of the great secrets in baseball. While we've had journalists, including myself, that have toured their facilities and seen their capabilities, few teams have made use of them. Even then, we don't know much about it. Since Moneyball, where Dr. Glenn Fleisig and his facilities were referenced in their advanced pitching program, we've never really gotten to see the results. Fleisig and the teams that use the facility are bound by privilege in most cases, but when Webb spoke up about his results at a recent session, the door cracked open a bit. The Diamondbacks' pitcher was quoted as saying that he was able to determine from his testing at ASMI that his arm angle was too high. He said that all the work he's done may have been a waste given that he was doing it wrong. I spoke with Dr. Fleisig, though he couldn't speak about Webb specifically. He seemed a bit surprised that Webb had gone on-record, but pleasantly so. "He got it right," Fleisig said in reference to the ideal arm angle. The abduction angle is created by the arm in relation to the body—in this photo, Astros pitcher Roy Oswalt's arm is at or near 90 degrees, which is within the 86-102 degree range found by ASMI's studies. One of the tougher things to understand is that the tilt of the shoulders doesn't affect the abduction angle. Again in a photo, we see Oswalt demonstrating a hard shoulder tilt. Oswalt's abduction angle in this picture looks slightly below 90 degrees, but I asked Fleisig if someone could see that angle. His answer? A very quick "No, it's impossible." 

ASMI uses an array of eight high-speed camera taking measurements from a series of markers. It's very similar to what is used to create video games. (Hmm, I wonder if EA knows the joint loads for Tim Lincecum.) Webb came to ASMI last week and went through a series of exams and tests. He was seen not only by Dr. James Andrews, but by Fleisig in the lab and by Kevin Wilk, one of the preeminent rehab minds who works at a connected facility in Birmingham. That holistic approach allowed them to send a report back to the Diamondbacks and to Webb that gave him an actionable plan. While Fleisig couldn't give any specifics, I did ask him if a player coming off surgery had an "easy fix" like an arm angle adjustment, would he put him on his fantasy team? Flesig, a long-time fantasy player, laughed and said "Yeah, I could see picking a guy like that up." In total, knowing that Webb has gone through this and found something fixable, it's the most positive news he's had in a while. There's still no solid timeframe for his return, but I'd expect some progress in the next 15 days that will allow us to get a better handle on that issue. Between work on his mechanics, stamina, and a needed rehab assignment, the All-Star break is looking like a reasonable ERD. If Webb is able to come back with good results, the questions will be why did they wait to have this kind of testing done and why aren't more teams doing this?

Homer Bailey (shoulder tightness, ERD TBD)
The problem with my job—and no, I'm not complaining—is that people expect answers rightthehellnow. Problem is, a lot of sports medicine is sitting around and waiting. Or in this case, scheduling an MRI. Sure, the Reds could pull some strings and get Bailey in up at Beacon if they wanted, but sometimes you have to wait to get a good image and understand exactly what's going on. That leaves everyone guessing, hoping, or just making stuff up. Bailey's shoulder was "tight" and the team elected to take the pitcher out. After the game, Bailey didn't seem too concerned, saying there wasn't pain, just an inability to get loose. Bailey was ineffective up to that point and in watching the video just before he was pulled, Bailey's being very stoic and then, at the 1.15 mark, they show him shaking his arm and then turning it in very specific ways. Even with this video, there's no way of knowing exactly what's going on. Chris Welsh, the color man for the Reds, talks of it being an "elbow twinge," though all information from Bailey and the team points to the shoulder. The imaging and examination by Dr. Tim Kremchek will give us some clarity as soon as Monday afternoon.

John Maine (shoulder instability, ERD 6/6)
I'll leave the soap opera that is the Mets aside here and focus on the injury and mechanical issues surrounding Maine. On twitter, @sportsfrog asked an interesting question. "When a team places a pitcher on DL with a shoulder issue, how often (does he) throw in the bullpen a day or two later?" The answer is normally no, but being unable to pitch in a game is different than being unable to throw. The difference is more than semantic. Maine's alleged mechanical issues led to reduced velocity and would indicate a weakened shoulder or some sort of inefficiency. Perhaps both, given Maine's luck. The Mets have pushed Maine to the DL, but given the situation with the pitching coach there, I'm not sure how they expect him to work through it. Maine has had an extended series of injuries, both major and minor, though I've never seen any reason to think he couldn't be returned to some form of effectiveness. We'll have to see if he can do that as a Met or whether he'll need to be shifted out. One possibility is reuniting him with Rick Peterson in Milwaukee. The Brewers lack pitching and have an outfield prospect or two that could be a nice return.

Jimmy Rollins (strained calf, ERD 6/10)
No staff likes to see a recurrence, but it has to sting even more for a solid staff like the Phillies. Rollins pulled up lame with a recurrence of his calf strain just days after returning from the DL and despite limits on his running. Even the hours of maintenance work being done didn't hold up in the face of one stride that overtaxed the muscle. Rollins felt it happening, he says, and was able to keep it from being quite as bad, something confirmed by imaging. The team is going to be even more conservative as the shortstop comes back a second time, so pronouncements that this will be "just a minimum" stay on the DL have to be taken in context. Expect a bit over the minimum, especially if he has any difficulties along the return path.

Brad Penny (strained lat, ERD 6/5)
It's hard enough to do the job of an athletic trainer without a player hiding an injury. That's the part that chapped Tony La Russa and the Cardinals after Penny mentioned that he'd been having trouble with his shoulder only after he'd been pulled from his last start. While there are indications that the injury happened—or at least went acute—during an at-bat, Penny's longstanding arm problems have to come into play here. The lat is a large muscle just below the shoulder and tends to be injured only when there's a kinetic chain problem. It's not often that a big muscle is the weak link. There's no discernible changes to Penny's mechanics, but there may be subtle changes given his various stops and his recent work with Dave Duncan. The Cards don't think that Penny will be gone much more than the minimum with this Grade I strain.

Austin Jackson (concussion, ERD 5/25)
Jackson might not start wearing the newer, more effective, but goofy-looking batting helmet after his close call on Saturday, but it's precisely this type of injury that that helmet was created to avoid. With a larger, deeper bill, the ball might not have ricocheted down into his eye, leaving Jackson with a shiner and a mild concussion. The Tigers are off on Monday, so the rookie center fielder will get another day off before the team makes a decision about his return. Medical staffs are taking concussions more seriously now, so even the slightest issue will cost him another game or two, but that's a good thing in the longer term. Whether Jackson takes another look at the newer helmets remains to be seen.

Grady Sizemore (bruised knee, ERD TBD)
Like Lost, there's still a lot of questions surrounding Sizemore. (Yeah, that's bitterness you hear. I spent six years watching an episodic version of Jacob's Ladder?) The team is still calling Sizemore's problem a bone bruise, but no one's said no to the idea that the center fielder will need surgery. There are growing rumblings that both are accurate and that we're dealing with a lesser version of a Carlos Beltran situation. At just 27 and in the midst of a long-term but team-friendly six-year deal, this could be devastating to Sizemore's future. There are lot of players that have had serious leg issues that have gone on to have nice, long careers, but all of them—Andre Dawson, Harold Baines, Edgar Martinez, and more—had to make adjustments. There's growing evidence that this isn't a trauma as well, with Sizemore's numbers showing decreasing range and some other statistical quirks that could be pointing to some physical change. The tests will show if this is a rest-and-heal or a hope-and-pray situation.

Orlando Hudson (bruised elbow, ERD 5/26)
Alexi Casilla (bone chips in elbow)
The Twins have some trouble up the middle with both second basemen on the roster not being second basemen. (Sorry, I know...) Hudson went down with a bruised elbow after he was hit with a throw. While it's not going to be a long-term issue, Hudson does have a history of being a slow healer and until he can play comfortably, manager Ron Gardenhire was willing to go with Casilla. Problem is that Casilla is having a hard time swinging the bat due to some bone chips in his elbow. He's able to deal with the intermittent pain, but not having a real backup is a real problem for the Twins. Add in Nick Punto's finger problems and it's a real roster sudoku. They'll juggle the lineup for the next couple days, hoping that Casilla can hold together and that they don't have to do something like see if Michael Cuddyer can still play the infield.

Matt Harrington
It's a little bit of sad history as Harrington, a Twins minor-leaguer, was suspended for a positive PED test. It's the substance that makes this notable, the first in baseball for a SARM. I alerted you to SARMs last year in an article here at BPro. Harrington and the Twins have refused all comment, but this one is intriguing. Harrington doesn't stand out in any way, but using an advanced substance like SARMs isn't something you'd expect someone outside an expert to be using. Yes, I know I was told that it would be in baseball quickly, but I expected it to be used by the more advanced users that have Victor Conte-style advisors. Harrington is probably not alone, but it does speak well of baseball's testing program to catch a player for an advanced substance. Compare this to the NFL's policy and media position in light of the Brian Cushing and Santana Moss stories. Baseball is proactive while the NFL is barely reacting at all.

Quick Cuts: With a near no-no, Daisuke Matsuzaka reminds us all why he could be good again. The Red Sox right-hander has got as much confusion surrounding him as a Lost episode. ... Kyle Lohse is having more trouble with his forearm. The Cardinals' right-hander will go for an exam and could be headed to the DL. ... One reason the Nationals inquired on Oswalt (they won't get him) was their need for innings. I've discussed this before, and with Scott Olsen hitting the DL, the need is stark. Olsen's shoulder tightened up and he'll have tests this week. ... Miguel Montero should start a rehab assignment later this week. The catcher should be back with the Diamondbacks by the first week of June, if things progress as planned. ... The Nats may push Ivan Rodriguez to the DL. His back may keep him out through the rest of the week as they try to break the spasms. ... The Phillies don't seem inclined to send Brad Lidge out on a rehab assignment. The closer will throw in the pen tomorrow and could be activated early next week. ... Koji Uehara has what is listed as a strained right elbow and is headed back to the DL. There's no timeline on a return for the Orioles' reliever. There's not much left in what was once a quality arm. ... Last year's sensation Clay Zavada had Tommy John surgery and the Diamondbacks' left-handed reliever will miss the rest of the season. ... Eric Chavez is calling his latest neck problem "career-threatening." The DH is headed for traction while he's on the 15-day DL, indicating a disc problem. ... Nationals catcher Chris Coste is heading for Tommy John surgery, and will miss the rest of 2010. ... The news about Jose Lima is just stunning. There were very few players that ever seemed so full of life.

30 comments have been left for this article. (Click to hide comments)

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Alex Canzoneri

Michael Harrington, not Matt. I'm sure Matt would love to still be close enough to baseball to be suspended, but alas.

May 24, 2010 06:27 AM
rating: 1
 
hessshaun

Jacob's Ladder link is broken. Lost watcher here, seems like my entire morning has been one reference or another. Regardless of the outcome, it's better than another cop or hospital show.

May 24, 2010 07:57 AM
rating: 4
 
One Flap Down

Jacob's Ladder? Not for the six seasons on the island and the first five seasons off the island. They made it pretty clear that all of that was real. It was only the flash-sideways in Season 6 that might hold up to the comparison, but even that was explicitly referred to as being a kind of after-life purgatory for all of them as opposed to a "flashes before your eyes as you die" deal like in Jacob's Ladder and, say, An Occurrence at Owl Creek Bridge.

May 24, 2010 10:51 AM
rating: 2
 
mketchen

Will,

The ending was Epic! Seems to me the alter reality from this season was a purgatory in a sense where they were just waiting to find each other again. Best show I have ever watched from start to end.

May 24, 2010 08:40 AM
rating: 2
 
dalbano

I think if you were looking for all of the Lost questions to be answered, you will be dissappointed. However, the show was never about answering all of the WTF moments. It was simply about the people and the ending couldn't have been any better if you focus on that aspect.

May 24, 2010 08:49 AM
rating: 2
 
dianagram

... except that Bobby Ewing didn't appear in the shower.

May 24, 2010 08:57 AM
rating: 0
 
redsfan1470

Your comment is correct, but the problem is that not everyone is willing to set aside all of the WTF moments.

I feel like I just got trolled into watching 6 seasons of a daytime soap opera.

May 24, 2010 14:06 PM
rating: 0
 
dianagram

re: Sizemore

Here's a possibly naive question ...

If Beltran and other athletes are using SynVisc to temper the pain/lack of protective tissue/fluid surrounding the joints, would there be any benefit to doing this as a PREVENTIVE measure ... PRIOR to engaging in the season-long wear and tear.

May 24, 2010 09:00 AM
rating: 0
 
BP staff member Will Carroll
BP staff

I'm getting conflicting answers on this. Much of the "con" argument is centered on what the acidic effect might be on healthy tissue.

May 24, 2010 10:04 AM
 
escapingNihilism

obligatory: anything on Beltran? seems to have been no news since his warning track jog two weeks ago.

May 24, 2010 09:32 AM
rating: -1
 
amazin_mess

Wondering the same thing.

May 24, 2010 15:32 PM
rating: 0
 
dantroy

With Span's shoulder contusion, Cuddyer may have to play CF instead of the INF. Or maybe they'll send Thome out there...;)

May 24, 2010 09:44 AM
rating: 0
 
Patrick

"The Twins have some trouble up the middle with both second basemen on the roster not being second basemen."

What does this mean?

Re: Lost. I agree that the questions were never all going to be answered. It's a show about a magical island where weird stuff happens. I just enjoyed the ride.

May 24, 2010 09:46 AM
rating: 1
 
BP staff member Will Carroll
BP staff

Oops ... my joke didn't make it past the editors. As written it was "The Twins have some trouble up the middle with their 2Bs on the roster being not 2Bs." Poor Hamlet joke.

May 24, 2010 10:06 AM
 
LouisArighi

Thanks for clearing that up.

May 24, 2010 15:48 PM
rating: 0
 
tfierst

So obviously the have a test that can detect SARMs now?

May 24, 2010 10:15 AM
rating: 2
 
Rob Moore

No comments on the Andre Ethier situation and the splint suggested to Conte by Gary Vitti? Wondering if this is something used in baseball previously.

May 24, 2010 11:19 AM
rating: 0
 
BP staff member Will Carroll
BP staff

Working on this one, but dont have anything solid yet.

May 24, 2010 19:53 PM
 
pobothecat

You've gotta love a phenomenon which comes with two illustrations only to be described as impossible to see.

I am sincerely curious and confused. It's the angle of the arm (part unspecified) to the body (part unspecified) that has nothing to do with shoulder tilt? Is it the angle of the upper arm to the socket? Of the forearm to the spine? The upper arm to the spine? The upper arm or forearm to the shoulders?

Dictionary says it's the movement of a body part away from the body's central axis. So we're talking angle of forearm to spine? But the 90-ish degree angle you mention would seem to be a measure of either upper arm to spine or forearm to upper arm.

And are we saying that, whatever this angle is, it is a range of optimal effectiveness or a range outside of which injury is most likely to occur? Or both? A follow-up here would be appreciated.

May 24, 2010 11:28 AM
rating: 2
 
BP staff member Will Carroll
BP staff

It's impossible to see in motion. Pictures - whole different story, but even then there's a degree of error.

Ok - demonstration. Put your arm "straight out" (level with the floor). That's a 90 degree abduction angle. Now tilt your body the opposite way. The abduction angle doesnt change, but the apparent angle does.

It's a measurement of the line of the spine/bodyline and the humerus (bone of the upper arm). And it's an optimal range. Far outside that and studies suggest an increase in forces to the joint.

May 24, 2010 19:56 PM
 
pobothecat

Gotcha. Thanks for the reply on that, Will. (Must be all those years on the driving range that makes this kind of stuff interesting to me now.)

May 25, 2010 12:54 PM
rating: 0
 
tommybones

Some people haven't seen the final episode yet.

May 24, 2010 11:39 AM
rating: 0
 
dalbano

If people haven't seen the episode yet they should stay off the web until they see it.

May 24, 2010 12:19 PM
rating: 6
 
pobothecat

ha ha

May 24, 2010 14:28 PM
rating: 0
 
dg

Any idea if Andy Marte will be back at the end of 15 days?

May 24, 2010 12:53 PM
rating: -1
 
dscala

any news about Tommy Hanson's dizziness during last start?

May 24, 2010 14:02 PM
rating: -1
 
OTSgamer

I understand there is a lot of uncertainty with Sizemore. That said, he was put on the 15-day DL retroactive to May 17th, and frankly it doesn't seem like he's going to come back at the end of that 15-day stint.

Is it reasonable to assume at this point that he's likely going to miss at least a few more weeks?

May 24, 2010 14:33 PM
rating: 0
 
ObviouslyRob

Shame to hear about Zavada. Who is there to fill the now-glaring great mustache vacuum?

May 24, 2010 15:26 PM
rating: 1
 
John Carter

I never caught an episode of "Lost", but I did catch "Jacob's Ladder" when it originally came out and it was one of the most moving movie experiences I ever had. Every eery or feverish feeling was milked to the extreme. It was story within a story within a story each brilliant and touching in it's way.

May 24, 2010 20:29 PM
rating: -1
 
drbnorce

There's growing evidence that this isn't a trauma as well, with Sizemore's numbers showing decreasing range and some other statistical quirks that could be pointing to some physical change. The tests will show if this is a rest-and-heal or a hope-and-pray situation..............i am not sure what u r suggesting here?
physical change? do u mean roids? has he gotten smaller?

May 25, 2010 14:30 PM
rating: 0
 
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